A nurse manager observes a staff nurse removing a used narcotic syringe from the sharps disposal container.
Which of the following actions should the nurse manager take first?
Create a disciplinary contract with the staff nurse.
Confront the staff nurse.
Collect information about the staff nurse's performance.
Report the incident to the state board of nursing.
The Correct Answer is B
Choice A rationale
Creating a disciplinary contract is an administrative action that may occur later in the process after a full investigation has been conducted. The nurse manager must follow specific organizational and legal steps before instituting formal punishment. Jumping straight to a contract ignores the immediate need to address the safety concern and understand the context of the nurse's behavior. The priority is immediate intervention and data collection rather than finalizing a long-term disciplinary outcome.
Choice B rationale
When a nurse manager observes a potentially illegal or dangerous action like tampering with a sharps container, the priority is to intervene immediately. Confronting the nurse serves to stop the behavior, secure the environment, and provide the nurse with an opportunity to explain their actions. This direct approach is the first step in the assessment of a critical situation, ensuring that any impaired practice or diversion of controlled substances is addressed without delay for safety.
Choice C rationale
Collecting information about performance is a necessary part of a thorough investigation into suspected substance abuse or diversion. However, this is a secondary step that follows the initial confrontation and immediate management of the situation. While review of medication logs and peer feedback is vital for building a case or determining the extent of the problem, the manager's first responsibility is to act on the direct observation they just witnessed.
Choice D rationale
Reporting the incident to the state board of nursing is a legal requirement in most jurisdictions when a nurse is suspected of diversion or impairment. This is a crucial step in protecting the public and maintaining professional standards. However, this report is typically made after the initial encounter and after the manager has gathered enough preliminary evidence to justify the claim. The manager must first deal with the individual in the moment before initiating external reports.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Obtaining a signature for informed consent is often a delegated task or a procedural requirement within a facility. While the nurse must ensure the client understands the procedure, the primary responsibility for explaining risks and benefits lies with the provider. Performing this task is a legal and ethical obligation but does not represent the high level of independent clinical judgment and decision-making that characterizes true nursing autonomy in a medical-surgical setting.
Choice B rationale
Autonomy in nursing refers to the ability to perform independent interventions based on clinical judgment and assessment findings. When a nurse identifies a report of unrelieved leg pain and chooses to measure calf circumference, they are independently initiating an assessment to screen for potential complications like deep vein thrombosis. This action is not a response to a direct order but a self-directed professional decision aimed at ensuring client safety and gathering essential diagnostic data.
Choice C rationale
Administering a scheduled medication at a specific time is an example of following a prescribed plan of care or a physician's order. While it requires clinical knowledge regarding the medication's effects and the necessity of giving levothyroxine on an empty stomach, it is a dependent nursing action. Autonomy involves the nurse's authority to make decisions beyond routine task execution, whereas medication administration is a standardized part of the daily nursing workflow and protocols.
Choice D rationale
Following facility protocols for reporting incidents like falls is a mandatory compliance activity designed to ensure institutional quality and risk management. While adherence to protocol is essential for professional practice, it represents the nurse’s role as an employee within a bureaucratic system. Autonomy, conversely, is demonstrated through the nurse's individual initiative and the application of their unique expertise to address specific client needs that may fall outside of pre-written scripts.
Correct Answer is C
Explanation
Choice A rationale
While financial stability is a component of any employment, it is not a defining hallmark of a profession. Professions are instead characterized by a specialized body of knowledge and a commitment to public service rather than just compensation. The focus on reasonable work does not capture the intense dedication or the ethical responsibilities inherent in nursing practice. Economic factors are secondary to the primary goal of providing expert, evidence-based care to patients.
Choice B rationale
This statement reflects a task-oriented job rather than a professional career. Professional responsibility in nursing involves a continuous commitment to patient outcomes and professional standards that often extends beyond the specific hours of a shift. The concept of accountability means the nurse remains responsible for the decisions made and the care delegated during their practice. Professionalism implies an ongoing dedication to the field, including participation in professional organizations and advocacy for patient health.
Choice C rationale
Professionalism is defined by the requirement for continuous education to maintain competency as medical science evolves. Autonomy is the ability to make independent clinical judgments based on a unique body of knowledge. Nurses exercise this by assessing patients and implementing interventions within their scope of practice. This characteristic distinguishes a profession from a technical trade, as it requires a high degree of personal responsibility, ethical decision-making, and a lifelong commitment to improving clinical skills.
Choice D rationale
While protocols ensure safety and consistency, strict adherence without any deviation or critical thinking contradicts the professional requirement for clinical judgment. Nursing involves assessing the unique needs of each patient and adjusting care plans accordingly. Professionals must use their expertise to determine when a standard protocol may not be appropriate for a specific clinical situation. Relying solely on standardized instructions reduces the nurse to a technician rather than a professional practitioner who manages complex care.
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